Provider Demographics
NPI:1669568838
Name:SOUTHEAST SURGERY, PC
Entity type:Organization
Organization Name:SOUTHEAST SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:FOXHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-270-8020
Mailing Address - Street 1:2648 AIMEE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3330
Mailing Address - Country:US
Mailing Address - Phone:334-270-8020
Mailing Address - Fax:334-409-0956
Practice Address - Street 1:4224 CARMICHAEL CT N
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3621
Practice Address - Country:US
Practice Address - Phone:334-270-8887
Practice Address - Fax:334-270-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016198208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty